PLEASE NOTE: Submitting this document to the Court does not mean that payment of the filing fee is deferred. A plaintiff proceeding in forma pauperis may also be subject to any fines, sanctions, court costs, or attorney’s fees that may be ordered by the Court.
Local Civil Rule 54.7 provides:
In all actions in which the fees of the marshal and the clerk are not required by law to be paid in advance and in which a seaman or party proceeding in forma pauperis prevails, either by judgment or settlement, all fees of the marshal and clerk must be paid before dismissal or satisfaction of judgment may be filed, unless otherwise ordered by the court. Counsel handling the payment of any settlement must confirm that all fees are paid, whether or not any dismissal or satisfaction of judgment entry is applied for. [Amended February 1, 2011].
When using this form, please make sure you have completed the following prior to submitting it to the Court:
• List all named defendants in the case caption at the top of the form.
• Respond to all questions within the form (no section should be left blank).
• Sign the document with a “wet” (handwritten) signature and date. (Typed and/or electronically signed documents are not permitted.)
• If you are incarcerated, the Statement of Account must be signed and dated by the Authorized Officer at the Institution where you are currently incarcerated.